Preventing perinatal suicide: an unmet public health need
Authors: Lauren A Kobylski, Jennifer Keller, Sherry Davis Molock, Huynh-Nhu Le
Journal: The Lancet Public Health (2023)

Deaths from suicide are a leading cause of death for individuals in the first year after childbirth, with up to 20% of global post-partum deaths occurring because of suicide.1Lindahl V Pearson JL Colpe L Prevalence of suicidality during pregnancy and the postpartum.Arch Women Ment Health. 2005; 8: 77-87Crossref PubMed Scopus (499) Google Scholar Suicidal ideation in the perinatal period is high, estimated at 8% internationally.2Xiao M Hu Y Huang S Wang G Zhao J Lei J Prevalence of suicidal ideation in pregnancy and the postpartum: a systematic review and meta-analysis.J Affect Disord. 2022; 296: 322-336Crossref PubMed Scopus (9) Google Scholar In the USA, rates of suicidal ideation during pregnancy increased by 100% between 2008 and 2018, with wide racial disparities; among Black individuals, prenatal suicidal ideation increased by 700%.3Tabb KM Dalton VK Tilea A et al.Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008–2018.J Affect Disord. 2023; 320: 263-267Crossref PubMed Scopus (0) Google Scholar Despite these statistics, research on perinatal suicidality is just beginning and research on perinatal suicide prevention is non-existent. Existing research has focused on establishing prevalence rates and ascertaining risk factors. Although this information is crucial to understanding the scope of deaths from suicide and the populations at highest risk of death from suicide, there is a substantial unmet need for evidence-based strategies to prevent perinatal deaths from suicide. Perinatal mood and anxiety disorders are the most common complication of pregnancy and childbirth, and are associated with adverse outcomes.4Accortt EE Wong MS It is time for routine screening for perinatal mood and anxiety disorders in obstetrics and gynecology settings.Obstet Gynecol Surv. 2017; 72: 553-568Crossref PubMed Scopus (60) Google Scholar These mood and anxiety disorders are among the strongest predictors of perinatal suicidality.5Orsolini L Valchera A Vecchiotti R et al.Suicide during perinatal period: epidemiology, risk factors, and clinical correlates.Front Psychiatry. 2016; 7: 138Crossref PubMed Scopus (101) Google Scholar Deaths from suicide are a top contributor to mortality of birthing parents, despite established interventions for perinatal mood and anxiety disorders, such as cognitive behavior therapy.4Accortt EE Wong MS It is time for routine screening for perinatal mood and anxiety disorders in obstetrics and gynecology settings.Obstet Gynecol Surv. 2017; 72: 553-568Crossref PubMed Scopus (60) Google Scholar High rates of perinatal suicidality have persisted, and even increased, indicating that interventions designed to prevent, identify, and treat perinatal mood and anxiety disorders are insufficient in preventing perinatal deaths from suicide. Although perinatal mood and anxiety disorders and perinatal deaths from suicide share many risk factors, they require distinct preventive approaches. There are numerous concerns related to the conduct of suicidality research. Researchers should ensure that safety protocols are in place if an individual's risk of death from suicide increases and referral to treatment becomes necessary. Measurement of perinatal suicidality is characterised by substantial heterogeneity in terms of how suicidality is assessed, the number of screening questions, and the administration method. A perinatal-specific suicidality assessment has yet to be developed; validation of such a tool will be necessary to better identify individuals at greatest risk of death from suicide and to make direct comparisons across studies of prevention strategies. Furthermore, minority ethnic communities are underserved regarding mental health treatment. Addressing access to mental health services is a necessary precursor to suicide prevention. Despite these obstacles, the potential effects of perinatal suicide prevention research are compelling. Further research is urgently needed to address increasing rates of perinatal suicidal ideation, worsening racial disparities, and mortality due to death from suicide. Addressing the vastly understudied problem of perinatal suicidality should be considered a public health priority. We declare no competing interests.